Introducing new groups onto the ward was not easy, and there were a number of specific challenges highlighted by the facilitators above, and described in similar accounts of running groups on inpatient wards (Hill, Clarke & Wilson, 2009; Jefford, Grandison & Pharwaha, 2010). In our study running the groups across a number of wards gave us the opportunity to compare the difficulties we encountered on each ward.
The success or failure of the group session each week was largely dependent upon the attitudes of the ward as a whole and the understanding and enthusiasm of the individual staff working on the ward that day. As described above by the service user volunteers, we encountered major differences between the mind-set of different wards even within the same hospital. Although each ward allocated a member of nursing staff to co-facilitate the groups (and this person received training and supervision about the groups) on some wards this person was not regularly available (i.e. not working that day or having been allocated other duties, such as ward round). This person was key in preparations before the group sessions, such as waking people up and reminding them about the group; making sure they
Hi Mary and to all concerned,
This is just a brief feedback on my roll as a group facilitator in a short time at [site] and a longer time in [other site] as part of the "what is real group"..!!
To be honest I’ve felt we could provide a lot more practical support in and alongside the group work we have done, i.e. to be able to have a resource of organisations and support groups to help in the follow on of patients, and for us as ex-service users to maybe be able to stay in touch to offer pastoral support or something similar for a short time.
These group sessions have shown me that this type of intervention has been really helpful in grounding patients if they’re in distressing circumstances. As a whole I’ve felt it is beneficial to them, yet feel a slightly more simplistic sort of practical day to day, here and now, group work would help more, so we have at times been flexible and tried that in the groups with some success!!
I’ve really enjoyed doing this and would look forward to any possibility of continuing to be of help...thanx
had received morning medication; being encouraging and positive about the group if people said they “couldn’t be bothered”, but not forcing people to come if they did not want to; helping to make refreshments and not being frightened to join in with the group discussion. They were also able to follow up with people after the sessions if necessary and act as a resource for patients on the ward who wanted more information in between the sessions. Therefore, we learnt that the role of the ward manager in championing and overseeing the attitudes and responsibilities of ward staff was essential. On wards which regularly ran other types of groups, such as generic recovery groups or morning meetings, this system worked relatively well, and other members of staff were usually happy to step in and fulfil these duties if the allocated person was not available. However, wards which had fewer structured groups and activities were usually those where the allocated member of staff was less available. Therefore, we frequently had to ask another member of staff to help out (often a nursing assistant or trainee nurse), who had not received any training about the group, did not know how to approach people about the group and was often uncomfortable joining the sessions. On occasion, these ‘substitute’ co-facilitators made unhelpful comments in the group which went against the group philosophy, although this is understandable, as they may never have been exposed to alternative ways of thinking about mental health before, it did not help group cohesiveness when the facilitators had obviously different approaches. However, it was encouraging to observe that often ‘substitute’ co- facilitators, who had not spoken in the group, would ask questions afterwards and say they had enjoyed the session and would like to back again.
In order to facilitate the running of groups on inpatient wards it is essential that support for staff co- facilitators also comes from a managerial level, meaning that ward managers, matrons and service directors must also value groups and see the potential benefit to inpatients, staff and the therapeutic ward environment; and actively champion these concepts to allow change at the frontline of inpatient care. The staff co-facilitators needed the support of managers not only to attend the group sessions for 1.5 hours a week; but to attend training and monthly group supervision sessions, to have time to spend encouraging participants, and to deal with any incidents if people became distressed in the groups. Whilst this sounds like a big ask, those members of the nursing team who did regularly facilitate the
groups said that they learnt a lot themselves, especially from hearing the stories of recovered service users. They also felt the groups helped them get to know participants better, understand their
difficulties more, and improve their interactions with participants outside of the sessions. We also received positive feedback from a manager on one ward who thought that the groups had a calming effect on the ward as a whole because the group of service users who experienced psychosis were often some of the most challenging.